• 4 min read

Azure Cosmos DB: A competitive advantage for healthcare ISVs

With the proliferation of patient information from established and current sources, accompanied with scrupulous regulations, healthcare systems today are gradually shifting towards near real-time data integration.

This blog was co-authored by Shweta Mishra, Senior Solutions Architect, CitiusTech and Vinil Menon, Chief Technology Officer, CitiusTech

CitiusTech is a specialist provider of healthcare technology services which helps its customers to accelerate innovation in healthcare. CitiusTech used Azure Cosmos DB to simplify the real-time collection and movement of healthcare data from variety of sources in a secured manner. With the proliferation of patient information from established and current sources, accompanied with scrupulous regulations, healthcare systems today are gradually shifting towards near real-time data integration. To realize such performance, healthcare systems not only need to have low latency and high availability, but should also be highly responsive. Furthermore, they need to scale effectively to manage the inflow of high speed, large volumes of healthcare data.

The situation

The rise of Internet of Things (IoT) has enabled ordinary medical devices, wearables, traditional hospital deployed medical equipment to collect and share data. Within a wide area network (WAN), there are well defined standards and protocols, but with the ever increasing number of devices getting connected to the internet, there is a general lack of standards compliance and consistency of implementation. Moreover, data collation and generation from IoT enabled medical/mobile devices need specialized applications to cope with increasing volumes of data.

This free-form approach provides a great deal of flexibility, since different data can be stored in document oriented stores as business requirements change. Relational databases aren’t efficient in performing CRUD operations on such data but are essential for handling transactional data where consistent data integrity is necessary. Different databases are designed to solve different problems, using a single database engine for multiple purposes usually leads to non-performant solutions. Whereas management of multiple types of databases is an operational overhead.

Developing distributed global scale solutions are challenged by the capability and complexity of scaling databases across multiple regions without compromising performance, and while complying with data sovereignty needs. This often leads to inefficient management of multiple regional databases and/or underperformance.


Azure Cosmos DB has the ability of polyglot persistence, which allows it to use a mix of data store technologies without compromising on performance. It is a multi-model, highly-available, globally scalable database which supports proven low latency reads and writes. Azure Cosmos DB has enterprise grade security features and keeps all data encrypted at rest.

Azure Cosmos DB is suited for distributed global scale solutions as it not only provides a turnkey global distribution feature but can geo-fence a database to specific regions to manage data sovereignty compliance. Its multi-master feature allows writes to be made and synchronized across regions with guaranteed consistency. In addition, it supports multi-document transactions with ACID guarantees.

Use cases in healthcare

Azure Cosmos DB works very well for the following workloads.

1. Global scale secure solutions

Organizations like CitiusTech that offer a mission-critical, global-scale solution should consider Azure Cosmos DB a critical component of their solution stack. For example, An ISV developing a non-drug treatment for patients through a medical device at a facility can develop web or mobile applications which store the treatment information and medical device metadata in Azure Cosmos DB. Treatment information can be pushed to medical devices at global facilities for the treatment. ISVs can comply to the compliance requirement by using geo-fencing feature.

Azure Cosmos DB can also be used as a multi-tenant database with carefully designed strategy. For instance, if a tenant has different scaling requirements, different Azure Cosmos containers can be created for such tenants. In Azure Cosmos DB, containers serve as logical units of distribution and scalability. Multi-tenancy may be possible at a partition level within an Azure Cosmos container, but needs to be designed carefully to avoid creating hot-spots and compromising the overall performance.

2. Real-time location system, Internet of Things

Azure Cosmos DB is effective for building a solution for real-time tracking and management of medical devices and patients, as it often requires rapid velocity of data, scale, and resilience. Azure Cosmos DB supports low latency writes and reads so that all data is replicated across multiple fault and update domains in each region for high availability and resilience. It supports session consistency as one of its five consistency levels which is suitable for such scenarios. Session consistency guarantees strong consistency within a session.

Using Azure Cosmos DB also allows scaling of processing power, this is useful for burst scenarios and also provides elastic scale petabytes of storage. This enables request units (RU’s) to be programmatically adjusted as per the workload.

CitiusTech worked with a leading provider of medical grade vital signs and physiological monitoring solution to build a medical IoT based platform with the following requirements:

  • Monitor vitals with medical quality
  • Provide solutions for partners to integrate custom solutions
  • Deliver personalized, actionable insights
  • Messages and/or device generated data don’t have a fixed structure and may change in the future
  • Data producer(s) to simultaneously upload data for at least 100 subjects in less than two seconds per subject, receiving no more than 40*21=840 data points per subject, per request
  • Data consumer(s) to read simultaneously, data of at least 100 subjects in less than two seconds, producing no more than 15,000 data points per data consumer
  • Data for most recent 14 days shall be ready to be queried, and data older than 14 days to be moved to a cold storage

CitiusTech used Azure Cosmos DB as a hot storage to store health data, since it enabled low latency writes and reads of health data that was generated by the wearable sensor continuously. Azure Cosmos DB provided schema agnostic flexible storage to store documents with different shapes and size at scale and allowed enterprise grade security with Azure compliance certification.

The time to live (TTL) feature in Azure Cosmos DB automatically deleted expired items based on the TTL value. It was geo-distributed with its geo-fencing feature to address data sovereignty compliance requirements.

Solution architecture

Diagram showing architecture of data flow in CitiusTech's solution using Azure Cosmos DB

Architecture of data flow in CitiusTech’s solution using Azure Cosmos DB

Key insights

Azure Cosmos DB unlocks the potential of polyglot persistence for healthcare systems to integrate healthcare data from multiple systems of record. It also ensures the need for flexibility, adaptability, speed, security and scale in healthcare is addressed while maintaining low operational overheads and high performance.

About CitiusTech

CitiusTech is a specialist provider of healthcare technology services and solutions to healthcare technology companies, providers, payers and life sciences organizations. CitiusTech helps customers accelerate innovation in healthcare through specialized solutions, healthcare technology platforms, proficiencies and accelerators. Find out more about CitiusTech.